<img style="float: right;" src="https://opedge.com/Content/OldArticles/images/2008-10_07/tim1.jpg" hspace="4" vspace="4" /> <b>Tim Collins' dreams consisted of many things,</b> but never of hospitals and prosthetic clinics, becoming "Mr. Mom," or needing to don 15 pounds of plastic in order to be independent. At the age of 39, he was an active man who valued his work and leisure time. He enjoyed hunting, fishing, skiing, gardening, and golf. Working as an electrical lineman for a New York power company, he loved being high atop a power pole dealing with high voltage and took all the overtime he was offered. Newly married, he and his wife, Kim, dreamed of the family they would have and places they would visit. But on October 30, 1997, only 26 days after the couple exchanged their wedding vows, those dreams nearly ended when Collins was taken to the emergency room fighting for his life. Lack of proper communication led Collins to service an energized 2,700-volt transformer, resulting in current flowing up and down each of his arms, but fortunately not across his chest. A substation a few miles away sensed the break in current and opened the circuit as a safety precaution; however, Collins was unable to let go until the next opening, seconds later. As is common with electrical injuries, massive blood clots formed in his legs and underarms. Though surgeons were able to save Collins' life, they could not save his left shoulder; his right elbow was eventually lost, too. His right arm required rigorous daily wound care in an attempt to salvage the small strip of bicep remaining. For one month, the open wound was exposed to a daily dose of pure oxygen within a hyperbaric chamber. <h4>Time Does Not Necessarily Heal All Wounds</h4> Unless specifically questioned, Collins does not talk about all that he lost in the accident 11 years ago. "Nobody is prepared for anything like this," he says, his voice reflective and solemn. "[Losing both arms is] as frustrating as you can imagine. It's like running as fast and as hard as you can into a brick wall." <table class="clsTableCaption" style="float: right; width: 44.7466%; height: 215px;"> <tbody> <tr> <td style="width: 100%;"><img src="https://opedge.com/Content/OldArticles/images/2008-10_07/tim2.jpg" alt="Holmes explains to Collins the modifications he is making to one of Collins' prostheses." /></td> </tr> <tr> <td style="width: 100%;">Holmes explains to Collins the modifications he is making to one of Collins' prostheses.</td> </tr> </tbody> </table> Losing a limb, no matter which one, poses challenges to the individual; however, the obstacles are arguably greater for upper-limb amputees. As Collins' clinician, Don Holmes, CP, Northern Orthopedic Lab Inc., Watertown, New York, explains, "The injury and prosthesis are more difficult to conceal, and the limitations inherent to this type of injury are ten-fold, including lack of sensory feedback in the fingers and loss of fine manipulation. However, Tim's attitude of acceptance and determination to keep moving on, rather than...resentment, makes him stand out." Once fiercely independent, Collins now requires assistance from the moment he gets out of bed. Not only does he need help fastening the buckles of the harnessing system that secures his two prostheses to his body, he is also dependent upon the Workman's Compensation Insurance that provides him with the financial means to pay for the arms. Despite these daily frustrations, Collins can often be heard echoing a life lesson his father taught him: "Play the cards you are dealt." Collins may have been dealt a bitter hand, but the courage with which he plays it out is incredible. Four days after being released from the hospital, he suggested that he and Kim go out to eat. He counters children's stares by saying, "Hello" and "Would you like to know more about my arms?" <h4>Finding the Right Prosthetist</h4> Although he works hard to keep a voice among the many healthcare providers and case managers who comprise his continuum of care, ultimately his fate is in the hands of the few prosthetists who practice in upstate New York. Developing a long-term relationship with a local prosthetist proved difficult for Collins, as there are only a handful of prosthetists who practice long-term in upstate New York. Collins' first prosthetist resigned in 2001, forcing him to call the company headquarters to find someone who could help him continue his therapy. He traveled to Ohio for weeks at a time to develop the strength to use higher-level devices. Before then, he had been convinced that his right bicep was nonexistent, but after working with John Billock, CPO, Orthotics & Prosthetics Rehab Engineering Centre Inc., Warren, Ohio, a very weak muscle signal was found. With newfound hope, Collins spent much of his time away from the clinic engaging the small strip of muscle to increase the signal strength and produce a viable myoelectric site. "I even sat in front of the television and flexed," he says. The next time Collins was tested, the signal had increased from three millivolts to 14 millivolts. Not bad, considering that their goal was only seven! <table class="clsTableCaption" style="float: right; width: 40.1118%; height: 245px;"> <tbody> <tr> <td style="width: 100%;"><img src="https://opedge.com/Content/OldArticles/images/2008-10_07/tim3.jpg" alt="Don Holmes, CP, points out a signature line for Tom Collins." /></td> </tr> <tr> <td style="width: 100%;">Don Holmes, CP, points out a signature line for Tom Collins.</td> </tr> </tbody> </table> Today, Collins is beyond proficient in his Motion Control prostheses. Over the years he has opted for functionality over cosmesis, and for the most part he uses hooks instead of the attachable hand, and only one prosthesis. "If I can't do it with my right arm, I just let others do it," Collins jokes. "Often if I have on both arms, I tend to do much more than I should. I should only lift three pounds with the electric elbow." Since the cost of repairing the arms is so great, he tries not to overwork them. By wearing only his transhumeral unit, he also sidesteps an extra eight pounds. Kim says she took the whole ordeal much harder than her husband did. Her dreams of being idealistic carefree newlyweds were crushed, and she was forced to become a caregiver. "I was totally lost in the beginning," she says. She credits her husband and his inner strength with helping her get through toughest times. The couple also points to advice given to the late Christopher Reeves, which has also helped their marriage; he was warned that it is not good for a wife to be the main caregiver for her husband, as the two roles easily become blurred. Fortunately, Kim has gradually been relieved of that responsibility, allowing her to hold part-time jobs. Presently, she is working full time. <h4>Dreams Rekindled, Dreams Renewed</h4> The couple moved forward with their dreams of a family, and in 1999 their daughter Josie was born. "Josie is the biggest blessing," Collins says. "She is probably the reason that I am here." Josie is the only one in the family who does not remember a time before Collins' amputation, and when asked how life is with her father's disabilities, she responds that he is "just my dad." Collins has been a self-proclaimed "Mr. Mom" since she was three. While he has many visions of being a motivational speaker and developing safety programs for companies, "for now my life is Josie and her sporting events," he says. "I take her to school each day. We have a lot of father/daughter time. We help each other a lot." Collins exemplifies not only how to "play the cards dealt" but also how to move forward when they are knocked out of your hand. He has performed a number of hospital peer visits, talking with those who have found themselves in similar situations. His words and his presence remind them that they are not alone in their struggle, and that they can learn how to hold the cards they have been dealt. Collins and Holmes continue to brainstorm about how they can streamline suspension and function, including modifying his prostheses to eliminate the need for others to help him don them and secure the buckles. The game is still in session, and Collins continues to actively play his hand. <i>Chelan M. Keeter, BSE, CNA, is currently pursuing a nursing degree in New York state.</i>
